This application, "A Study of Cancer Diagnosis as a Risk Factor for Personal Bankruptcy," addresses broad Challenge Area (09) Health Disparities, and Challenge Topic 09-MD-102: Trans-disciplinary Research to Integrate the Biological and Non-biological Determinants of Health to Address Health Disparities. Bankruptcy may represent a unique and heretofore unstudied determinant of health disparity. In 2008, there were more than 1 million personal bankruptcy filings, equivalent to 1 in 120 American households. Moreover, corresponding with the recent economic downturn, bankruptcy filings are increasing at an alarming rate, more than doubling since 2006. Persons entering bankruptcy following a severe illness may experience difficulties obtaining health insurance or accessing health care providers, and may not be able to complete acute treatment for the disease or obtain care for related long-run adverse effects. In a recent survey, 28% of individuals filing for bankruptcy indicated that illness or injury was a primary cause. However, because surveys of illness and bankruptcy have largely relied on self report, the true relationship remains controversial. Bankruptcy may be a particular concern for persons who are diagnosed with cancer. Media reports have highlighted cases where cancer has caused financial hardship, including bankruptcy. Among the 1.4 million persons diagnosed with cancer each year, the number filing for bankruptcy is unknown. The overall goal of this project is to determine the impact of a diagnosis of cancer on individuals'risk of incurring personal bankruptcy. To accomplish this goal, study investigators have obtained special dispensation from the Chief Judge of the U.S. Bankruptcy Court-Western District of Washington to link person-level bankruptcy records with Western Washington Surveillance Epidemiology and End Results (SEER) cancer registry records and Washington State driver's license records. This innovative study represents the first use of these databases to study cancer-related bankruptcy. The study design does not rely on self-reported data, thereby overcoming inherent weaknesses in previous research. Using a retrospective cohort design, we will estimate the relative risk of bankruptcy for adults diagnosed with cancer between 1995 and 2008 compared to adults without cancer. We will match cancer cases identified from Washington SEER records to age- and sex-matched individuals without cancer from driver's license records. Using the linked database, we will evaluate the impact of age, sex, race and ethnicity, and the patient's cancer (including cancer type, stage at diagnosis, year at diagnosis, and initial treatment) on bankruptcy risk. In separate analyses, we will link neighborhood-level Census Bureau records to evaluate the influence of socioeconomic variables (e.g., average income, percentage of home ownership). We will also examine the impact of regional factors such as the Washington State bankruptcy exemption level, lawyers per capita, and state income growth. Finally, we will examine the impact of the Bankruptcy Abuse Prevention and Consumer Protection Act of 2005 on bankruptcy filings among cancer patients, both in general and compared to persons without cancer. Our study will provide rigorous scientific evidence characterizing the relationship between cancer and personal bankruptcy. We expect these results to inform health care policy discussions. Bankruptcy may represent a unique and heretofore unstudied potential source of health disparity. In this study, we have formed a novel partnership with the Federal Bankruptcy Court and the National Cancer Institute's SEER cancer registry to link bankruptcy records for cancer patients and a matched control population without cancer. If we find that cancer patients experience excess rates of bankruptcy compared to persons without cancer, our results will have important implications for those researching the causes of cancer disparity, and for policymakers seeking to mitigate the economic as well as clinical burden of persons with cancer.